Special notice: Important policy changes

Mar. 2025Important Notices

Effective May 1, 2025, the following policies will be retired and replaced with prior authorization policies. For more information, please visit upmchp.us/policiesandprocedures.

  • Brachytherapy-MP.220 is being retired and will be replaced by Brachytherapy-MP.PA.139.
  • Implantable Loop Recorder (Subcutaneous) Cardiac Rhythm Monitor – MP.165 is being retired and will be replaced by Implantable Loop Recorder (Subcutaneous) Cardiac Rhythm Monitor – MP.PA.140.

  • Radiation Therapy, External Beam (EBRT) and Intensity-Modulated (IMRT) – MP.034 is being retired and will be replaced with Radiation Therapy, External Beam (EBRT) and Intensity-Modulated (IMRT) – MP.PA.142.

  • Radiation Therapy - SRS and SBRT – MP.060 is being retired and will be replaced with Radiation Therapy - SRS and SBRT – MP.PA.143.

  • Sleep Medicine – Sleep Study – MP.157 is being retired and will be replaced with Sleep Medicine – Sleep Study – MP.PA.144.

Again, prior authorization will be required for all of the new policies beginning May 1.

If you have any questions or concerns about these policy changes, please contact your physician account executive or call Provider Services at 1-866-918-1595.

Thank you for the excellent care and support you provide to our members.


Recent Announcements

UPMC-GoHealth Urgent Care centers opening

UPMC has formed a joint venture with GoHealth Urgent Care. MedExpress locations in PA and WV and UPMC Urgent Care and Express Care centers are transitioning to UPMC-GoHealth Urgent Care centers.
Jun. 2025Important Notices

Fostering Trust in Vaccinations Through Shared Decision Making

Please join us for a live, CME-accredited webinar on Thursday, September 11, from noon to 1 p.m. that will provide an overview of fostering trust in vaccinations through shared decision making.
May 2025Education/Webinars

Pause in Prior Authorization Policies

On April 1, 2025, we announced that UPMC Health Plan would start requiring prior authorization for certain services. Please note that we are delaying or changing the implementation of prior authorization for some of these services, as described below.
May 2025Important Notices